Ultrasound Guıded Adductor Canal Block vs Perıcapsular Nerve Group Block in Knee Artroplasty

NCT06203483 | Completed

• 1 other identifier: Bursa City Hospital 6
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Knee arthroplasty surgery numbers are increasing depending on joint deformities and cartilage degenerations. Severe postoperative pain may occur in these patients due to surgery and the placed prosthesis. The aim of study is to compare the effectiveness of AKB and PENG block for postoperative analgesia management after knee arthroplasty.

Conditions

Knee Disease; Knee Osteoarthritis; Knee Arthropathy

Keywords

Total Knee Arthroplasty; Postoperative Analgesia Management; Adductor Canal Block; Perıcapsular Nerve Group Block

Outcome Measures

Primary Outcomes (1)

• Global recovery scoring system (patient satisfaction scale)

  The investigators will use the Turkish version of Quality of Recovery / QoR-15 questionairre PART A How have you been feeling in the last 24 hours? (0 to 10, where: 0 = none of the time \[poor\] and 10 = all of the time \[excellent\]) 1. Able to breathe easily 2. Been able to enjoy food 3. Feeling rested 4. Have had a good sleep 5. Able to look after personal toilet and hygiene unaided 6. Able to communicate with 7. Getting support from hospital doctors and nurses 8. Able to return to work or usual home activities 9. Feeling comfortable and in control 10. Having a feeling of general well-being PART B Have you had any of the following in the last 24 hours? (10 to 0, where: 10 = none of the time \[excellent\] and 0 = all of the time \[poor\]) 11. Moderate pain 12. Severe pain 13. Nausea or vomiting 14. Feeling worried or anxious 15. Feeling sad or depressed

  The quality of recovery will be evaluated out of a total of 150 points according to the QoR-15 test to be applied at the portoperative 24th hour.

Secondary Outcomes (2)

• Postoperative pain scores (Numerical rating scale) (0-meaning "no pain" to 10-meaning "worst pain imaginable")

  Patients will be evaluated at the first 24 hours period postoperatively.

• The use of rescue analgesia

  Meperidine consumption will be recorded at the first 24 hours period postoperatively.

Study Arms (2)

Adductor canal block

ACTIVE COMPARATOR

Adductor canal block will be performed at the end of the surgery. Patients will be administered tenoxicam (Tilcotil 20 mg flakon) 20 mg IV every 12 hours in the postoperative period. A patient controlled device prepared with 5 mg/ ml tramadol (100 mg-Contramal ® ampul) will be attached to all patients with a protocol included 10 mg bolus without infusion dose, 20 min lockout time and 4 hour limit. If the VAS score will be ≥ 4, 0,5 mg/kg-1 meperidine (Aldolan ampul 100 mg/2 ml) IV will be administered.

Drug: Adductor canal block

PENG block

ACTIVE COMPARATOR

PENG Block will be performed at the end of the surgery. Patients will be administered tenoxicam (Tilcotil 20 mg flakon) 20 mg IV every 12 hours in the postoperative period. A patient controlled device prepared with 5 mg/ ml tramadol (100 mg-Contramal ® ampul) will be attached to all patients with a protocol included 10 mg bolus without infusion dose, 20 min lockout time and 4 hour limit. If the VAS score will be ≥ 4, 0,5 mg/kg-1 meperidine (Aldolan ampul 100 mg/2 ml) IV will be administered.

Drug: PENG block

Interventions

Adductor canal block DRUG

A linear ultrasound probe will be placed medial to the patella, the probe will be advanced to cephalad, and the superficial femoral artery will be visualized. The block site will be confirmed by injecting 5 ml of saline around the saphenous nerve in the subsartorial region under ultrasound guidance. Then, 30 ml of local anesthetic solution containing 0.25% bupivacaine (Marcain 0.5% AstraZeneca, England) will be administered.

Adductor canal block

PENG block DRUG

The probe will be placed at the anterior superior level of spina iliaca, parallel to the inguinal ligament. The probe will be scanned gradually towards the caudal. After the anterior inferior of the spina iliaca is visible, the probe will be slightly turned medially until the hyperechoic shadow of the superior pubic ramus is visible. The psoas muscle tendon will be visualized above the superior pubic ramus, then 5 ml of saline will be injected under the psoas tendon and the block location will be confirmed. After that 30 ml of 0.25% bupivacaine will be administered.

PENG block

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• American Society of Anesthesiologists (ASA) classification I-II
• Scheduled for total knee arthroplasty under spinal anesthesia

You may not qualify if:

• history of bleeding diathesis
• receiving anticoagulant treatment,
• known local anesthetics and opioid allergy,
• infection of the skin at the site of the needle puncture,
• pregnancy or lactation,
• patients who do not accept the procedur

Sponsors & Collaborators

• Bursa City Hospital: lead

Study Sites (1)

Mürsel Ekinci

Bursa, Turkey (Türkiye)

Location

Related Publications (5)

• Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am. 2011 Jun 1;93(11):994-1000. doi: 10.2106/JBJS.I.01618.

  PMID: 21531866 BACKGROUND

• Jiang X, Wang QQ, Wu CA, Tian W. Analgesic Efficacy of Adductor Canal Block in Total Knee Arthroplasty: A Meta-analysis and Systematic Review. Orthop Surg. 2016 Aug;8(3):294-300. doi: 10.1111/os.12268.

  PMID: 27627711 BACKGROUND

• Kapoor R, Adhikary SD, Siefring C, McQuillan PM. The saphenous nerve and its relationship to the nerve to the vastus medialis in and around the adductor canal: an anatomical study. Acta Anaesthesiol Scand. 2012 Mar;56(3):365-7. doi: 10.1111/j.1399-6576.2011.02645.x.

  PMID: 22335278 BACKGROUND

• Sahoo RK, Jadon A, Sharma SK, Nair AS. Pericapsular nerve group (PENG) block for hip fractures: Another weapon in the armamentarium of anesthesiologists. J Anaesthesiol Clin Pharmacol. 2021 Apr-Jun;37(2):295-296. doi: 10.4103/joacp.JOACP_295_20. Epub 2021 Jul 15. No abstract available.

  PMID: 34349384 BACKGROUND

• Manickam B, Perlas A, Duggan E, Brull R, Chan VW, Ramlogan R. Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal. Reg Anesth Pain Med. 2009 Nov-Dec;34(6):578-80. doi: 10.1097/aap.0b013e3181bfbf84.

  PMID: 19916251 BACKGROUND

MeSH Terms

Conditions

Osteoarthritis, Knee

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: The patient and the outcomes assessor who performs postoperative pain evaluation will not know the group
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assoc Prof

Model Details: There are two models for this study. Adductor canal block group, and pericapsular nerve group block group

Study Record Dates

• First Submitted: January 3, 2024
• First Posted: January 12, 2024
• Study Start: January 20, 2024
• Primary Completion: March 10, 2024
• Study Completion: June 10, 2024
• Last Updated: March 31, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)